title: Congenital stenosis and adjacent segment disease in the cervical spine.
abstract: Symptomatic adjacent segment disease (ASD) after anterior cervical fusion (ACF) is reported in 25% of patients at 10 years postoperatively. Debate continues as to whether this degeneration is due to the natural history of the disk or the changed biomechanics after ACF. This study explored whether congenital stenosis predisposes patients to an increased incidence of ASD after ACF. A retrospective review of 635 patients with myelopathy or radiculopathy was performed; 364 patients had complete records for review. Patients underwent 1- to 5-level ACF (94 one-level, 145 two-level, 79 three-level, 45 four-level, and 1 five-level). Radiographs were evaluated for bony congenital stenosis using validated parameters, and ASD was measured according to Hilibrand's criteria and correlated with symptomatic ASD. Congenital stenosis was found in 21.7% of patients and radiographic ASD in 33.5%, with a significant association between these parameters. However, symptomatic ASD occurred in 11.8% of patients; no association between congenital stenosis and symptomatic ASD or myelopathy and ASD was found. Clinical results demonstrated excellent or good Robinson scores in 86.2% of patients and Odom scores in 87% of patients. Despite mostly excellent to good outcomes, symptomatic ASD is common after ACF. Although congenital stenosis appears to increase the incidence of radiographic ASD, it does not appear to predict symptomatic ASD.
authors.forename: Jason David
authors.initials: JD
authors.lastname: Eubanks
authors.forename: Jon
authors.initials: J
authors.lastname: Belding
authors.forename: Erik
authors.initials: E
authors.lastname: Schnaser
authors.forename: Andrew
authors.initials: A
authors.lastname: Rowan
authors.forename: Gable
authors.initials: G
authors.lastname: Moffitt
authors.forename: John
authors.initials: J
authors.lastname: Weaver
authors.forename: Michael S
authors.initials: MS
authors.lastname: Reich
authors.forename: Chris
authors.initials: C
authors.lastname: Bechtel
authors.forename: Ke
authors.initials: K
authors.lastname: Xie
authors.forename: Abhiram
authors.initials: A
authors.lastname: Gande
authors.forename: Justin
authors.initials: J
authors.lastname: Hohl
authors.forename: Brett
authors.initials: B
authors.lastname: Braly
authors.forename: Alan
authors.initials: A
authors.lastname: Hilibrand
authors.forename: James D
authors.initials: JD
authors.lastname: Kang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000151:congenital* / Q000453:epidemiology; D012189:Retrospective Studies; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000453:epidemiology / Q000209:etiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult